PEG'97 Application Form

Surname:....................................................................................................

Firstname:..................................................................................................

Affiliation:...................................................................................................

Address:....................................................................................................

E-mail:.......................................................................................................

Phone:.......................................................................................................

Fax:...........................................................................................................



Registration

Total for registration ...........................................



Accommodation

Please reserve for me:
Date of arrival: ............................................................
Date of departure: .......................................................
Number of nights:.........................................................

Total for accommodation .......................



Payment

Payment for extra pages in the proceedings (20$ per page): .................... USD

TOTAL: ............... USD (for registration, accommodation and extra pages)

Please mark your choice:

Any special requests: (food preferences, etc.): ......................................
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